白三烯受体拮抗剂在儿童支气管哮喘并变应性鼻炎的临床研究

Clinical Efficacy Evaluation of Leukotriene Receptor Antagonists for Treatment of Coexisting Asthma and Allergic Rhinitis in Children

目的评价白三烯受体拮抗剂在治疗儿童支气管哮喘(哮喘)与变应性鼻炎(AR)的临床效果。方法选择2005年10月至2006年4月在我院儿科门诊诊断为哮喘并AR的患儿100例,随机分3组:口服孟鲁司特组(1组,吸入布地奈德都保加口服孟鲁司特5 mg,每晚1次);鼻内吸入激素组(2组,吸入布地奈德都保加鼻内吸入布地奈德鼻喷剂64μg,每日1次);对照组(仅吸入布地奈德都保)。观察期为6个月,每隔4周随访,记录患儿的临床症状评分;在治疗前及治疗后第8、24周检查肺功能,记录1秒钟用力呼气量占正常预计值的百分比(FEV1%)、鼻内分泌物嗜酸性细胞数、速效β2受体激动剂使用次数、所用药物分值以及哮喘急性发作次数及无症状天数。结果与治疗前比较,1组和2组明显降低了哮喘日间、夜间症状评分与鼻炎症状评分,差异均有统计学意义(P<0.05)。1组在哮喘日间、夜间症状评分与鼻炎症状评分、速效β2受体激动剂使用次数、所用药物分值与对照组比较,差异有统计学意义(P<0.05),而与2组比较,差异无统计学意义(P>0.05)。但1组在改善FEV1%、增加无症状天数及减少哮喘急性发作的次数均优于2组(P<0.05、P<0.001、P<0.05)及对照组(P<0.05、P<0.001、P<0.001)。在治疗后第24周,2组则比1组(P<0.05)与对照组(P<0.01)显著减少鼻内分泌物嗜酸细胞数。结论对哮喘并AR患儿兼顾上下气道的同治优于单一治疗。孟鲁司特可同时改善哮喘与AR的症状,改善肺功能,减少哮喘的急性发作,增加无症状天数,与吸入激素合用可为哮喘并AR患儿联合治疗的安全有效方法。

Objective To evaluate the efficacy of Leukotriene receptor antagonists in treatment of patients with asthma and allergic rhinitis（AR）. Methods This study was a 24-weck, randomized, control open real in which 100 children,who were diagnosed as mild to severe persistent coexisting asthma and AR, were enrolled. All cases were collected from pediatric out-patient department of the First Affiliated Hospital of Guru Medical College from October 1st,2005 to April 30th, 2006 and were divided into three groups. Montehkast group（ 1 group）： inhated budesonide turbuhahr and oral singulair（5mg/Qn） ; Intranasal corticosteroids group（2 group）： inhaled budesonide turbuhaler and intranasal budesonide nasal spray （64μg/Qd） ; Control group （ Control group） ： only inhaled budesonide turbuhaler. Efficacy was assessed by recording day, me and nighttime symptom scores, nasal symptom scores, the times of acute episode,the symptom-free days,the requirement for the weekly beta 2-receptor agonist and the medication scores,using a daily diary card and the recording work were repeated per four weeks in totally six months.Lung function （forced expiratory volume at 1 s inpredicted normal,FEV1% ） and nasal eosinophil count had been tested three times：bofore treatment,after treatment of 8th and 24th week. Results 1 group and 2 group, compared with the prior treatment （ P 〈 0.05）, were more effective in reducing daytime and nighttime symptom scores as well as nasal symptom scores. Although there was no difference in daytime and nighttime symptom scores,nasal symptom scores,the times of acute episode,the requirement for the weekly beta 2-reeeptor agonist and the medication scores between 1 group and 2 group（ all P 〉 0.05） ; 1 group was more statistically significant than 2 group in improving FEV1 （ P 〈 0.05）, having more symptom-free days（ P 〈 0. 001 ） and reducing the times of acute episode（ P 〈 0.05） ,and also much more significant than those in Control group（ P 〈 0.05, P 〈 0.001, P 〈 0.001）. After 24 weeks, nasal eosinophil count in 2 group was significantly decreased compared with that in 1 group（ P 〈 0.05）and Control group（ P 〈 0.01）. Conclusions The results of this study demonstrate that montehkast can effectively control asthma,relieve the symptom of AR,improve lung functien, and rescue the bronchial inflammation. Mentehkast combined with ICS will be a safe and effective method for the patient with coexisting asthma and AR.